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Home My WebLink About0041 PERCHERON WAY - Health r LOT 1 45-PERCHERON WAY1'� WEST BARNSTABLE A = 174 001 053 I i i i i I L�l TOWN OF BARNSTABLE LOCATION ?A& ocJ U2A�4 kMU` SEWAGE # "7 4 4 VILLAGE ASSESSOR'S MAP INSTALLER'S NAME&PHONE NO. E4 q2,,??s 3(),?,r— SEPTIC TANK CAPACITY / LEACHING FACILITY: (type) T— (size) NO. OF BEDROOMS BUILDER OR OWNER) y AVJ/iD 'ff PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet.. Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of 1 . 'ng facility) , /� .5 Feet. Furnished by �/ J IF • Il7 _ s3 w/ O THE COMMONWEALTH OF MASSACHUSETTS / LJ7, BOARD OF HEALTH v Appliratiun for Uiupuuttl Ularkii Tonstritrtiun Prrutit Application is hereby made for a Permit to Construct �K ) or Repair ( ) an Individual Sewage Disposal System at_....__... �. .... ..` ..... � �or2..V�!... .. ............................................... i� - ....... Lo ,� - r ° Location. dres n or Lot�. i/f .G ` / r �I Wner �D 7 ddress a .............................. !sl...1. nstallS.C.4( .............•-•-•^....... `. � � `=" �........_-�G�GC-f!LC S.. ............... / ..... Installer A dress /�� Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms------------- .Ex anion Attic Garbage Grinder Other—T e of Building .... No. of persons............................ Showers — Cafeteria QOther fixtures --------•......................•---•. �jrZ Design Flow...............�capaci..... -.._...gallons per 12 p?r day. Total !!�ly qpw......... ....... ............gallons. WSeptic Tank—Liquid capacity] .gallons Length.0..6..... Width..412l£1.... Diameter................ DeptI6....4_..... x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........I.......... Diameter.....J............. Depth below inlet.. ... .._. Total leaching area_Z .Y......sq. ft'. z Other Distribution box ( —) Dosing jj Percolation Test Resul Performed b ..... �`— -........... Date......6 V..5�7.......... ,tea Test Pit No. i.t...........minutes per inch Depth of Test Pit.... ` .... Depth to ground water........................ Test Pit No. minutes per inch Depth of Test Pit.................... Depth to ground water........................ t� ----- ---------•--......._..........--------------- ....... .-----------------------------------------------.............. O Description of Soil......I 7v. V ........................... ......•-------........................ ................. W .....-••---•---....-•.---•.•---••.................•----......------•----....----.............•---•-•-----------------•-------. ...- ........ -•--------------- .............. UNature of Repairs or Alterations—Answer when applicable.....:.......................................................................................... •-------•--•---...-•----------------------------•--.......-•---•------...........-•--•--•---•---•-•--..........----------------------------------------------........--•----•.......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of AI i LZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b e board of�heaa thy. Signed............ . ....... ....... -`�- ----------------••--•--•.. ....... ..plc 9� .................... Date Application Approved By..... C ..t -----.------••-•----------------- >l Date Application Disapproved for the following reasons:............................................................................................................ ...........--...---•-•--•-----•................•--•----..........------••-•-----•-•----••-•--••-•---••-•--.._..-•--•---•-------••------•-•---...........---••-•-------...----------.................._ qq Date PermitNo.......... "... 0.- -•--••-••-•--• Issued....................................................... Date r '`7r/ � f a THE COMMONWEALTH OF MASSACHUSETTS f ` BOARD OF HEALTH _ r �73b f 2 ---....._TC7 CJ'..J... ....OF.........��A.,�.R/.S-.?7 ! L F '•J t..... - Appliratioa t for Disposal Works Tunstrurtion Permit _t Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal ji- System at: / I�c1 i7l�liJn Locat... .A�dr , f ( (rt _ 7 �C✓ Z .... ................. ... /✓ L/:.A!:d Ldr ess� /�V �e ..L . ............................ Installer Address Type of Building - �...a.....Sq. feet U YP g Size Lot................. , _ Dwelling—No. of Bedrooms..........................................Expansion Attic ( ) =- Garbage Grinder ( ) / f a=.: Other—Type of Building------------------------ No. of persons............................ Showers ( ) — Cafeteria 1 d Other fixtures ...................................... . W Design`Flow.............:.1 rO_.. gal°lops'per .pet son per day. Total daily flow....... .:�.v.........._..........gallons. WSeptic Tank—Liquid capatyy ----•_gallons Length.��.._._�. .. Width.�;.lC�_.. Diameter:............... DepthS....�..... Z. Disposal-Trench No ....._.... Width............... .`Total Lengtt'.................... Total leaching area_.._.._..._____...sq. ft. .3 ---''- , ' Seepage.Pit No..__....,!_._..'__.. Diameter.....1_Z_..... Depth below inlet. .:...S.-...... Total leaching area2.`�-�---....sq. ft. Z Other Distribution_bkox (X) Dosing t nk ) ~" Percolation Test'Results) Performed by...... . . ._......t....:................. Date......Z.4�;/.- �'.- -.7''_..._.. Test Pit No.. Lt�. .......minutes per inch -Depth of Test Pit....7!2L ._. Depth to ground water........................ 44 Test Pit No.'2...............minutes per inch Depth of Test Pit...... ....... Depth to ground water................ --------------- ---•----.--.-•.... - Descriptionof Soil.............................................................................::�................................................. U .-------------------------••------•••-•-•-•••---•......----•----•--••••-•-•.............-••-•-•------•-----------•--•--•-••-•----•........................................... W -------------- -•------------------------------------------------------ •------------------ --------- ---------------------------- .:_....--------------- .--------- . U Nature of Repairs or Alterations—Answer when applicable....................................................... :...._....._._..._.._..._..__.......... Agreement: " The undersigned agrees to install the aforedescribed Individual Sewage;Disposal System in accordance with the provisions of TITL:. S of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health.Signed---....._� _ ' C, `ate/✓Z.1/, 'GIJ-- A �� 6' c ...L.. T , Application A roved B _ Date PP PP Y..__....._� _�_.. .vet:�........................•---------- • .`�'.-/7:..��.. 'wy Date Application Disapproved for the following reasons:............................................................................................................ ...................................................••---.._..----•-'-•----••--------.....--•--........................-------------------•-•-•--------------••-----------•-----...---•--...........•..... ✓ Date Permit No.......... ........ Issued. _ .........................•• Date t ____- e ------ R _: _ r_--__.._-_-,..-_._Rr_m____ _ v -------_-_.-___�_�____�___ �_ ��___�_, r_�__� F THE-COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r om Trrtifiratr of Tompliattrr THIS IS`\TO C RTIFY, That thje �n�dividual Sewage Disposal System constructed ( ) or Repaired. ( ) by--------------------- "=` = rr _... == :_:..4..... _._ Installer at........... -_...uc'..cc.�r. --------------------------------•-•-----------------_.--------------------------- .._......... has been installed in accordance with the provisions of TQIyLP, j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... �._�n__��_. dated............. .................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 5�5-Z,;G %r DATE '_1 ..: ....... .I_...:.._. Inspector................................ - _ ...._.._..,.......___-'•---_--_-_....__a.,....-I _m_..•....,..-- -- _---_--_ ..__4.---------------m_..__.----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........�. 4 !1................OF........ ?r�a�. NO.......; :.. / — . r FEE.-_h.. ...s. -- Dispasal Yorks Tonstrudiurt Permit Permission is hereby granted.. .;� ,�K. .nrr �. r ...� ;. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a Street C� � ......................... as shown on the application for Disposal Works Construction Permit No?��J(/Dated.......................................... M DATE. _ Board of Health I I W i r` f-:.Aq In, I _ 00, r" T4 b eE 1 - �� ( r .� y�,,�'.._�,.�� / �,,.''`�--� / ,(�'. 'G;'r='_��,, -„ t�,ht • . 1 .G+. FAG' GA tJ T� � �' c� ;{,• %` : -^ ' � -' _ rj . Fk MA[ L.l4" cLTtG +T. I �� ',- -�''`P_' �-�-! ` o .��=`.�,�.. '" � f !� t ,� r�,�` � -. , . t r-t�<s,�;� Tc F.�' {til 4.�o+C..�?1►�lz .E GJ.I�{ `�'._..._F �!i`'' 1i'�": � �yr��.'-'�� .� �Sl� � �� t W_1 � `—"� r ,-�L �;sX��4�'T 1�I�E G•�1�_�!l�.l i_:. 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